Abstract：
Neuroendocrine prostate cancer (NEPC) is generally an aggressive form of prostate cancer that can arise de novo or develop as a castration-resistant mechanism. While first-line platinum-based chemotherapy is effective against NEPC, its limited response duration and subsequent treatments pose significant clinical challenges. Standard second-line treatments have not been established due to the limited data available. The aim of this review was to reveal the current status of second-line therapy for NEPC. A literature search was conducted using PubMed and Web of Science and a total of 13 articles were included in this review. Prospective and retrospective studies demonstrated that treatment outcome of second-line therapy using platinum with etoposide or docetaxel was unfavorable and progression-free survival was 3 months or shorter. Amrubicin and irinotecan were also frequently used as second-line therapy, however, efficacy of these agents was modest and response duration was less than 6 months. NEPC patients with homologous recombination repair gene alterations may benefit from treatment with poly (ADP-ribose) polymerase (PARP) inhibitors. Ongoing clinical studies investigate various agents, including immune checkpoint inhibitors, molecularly targeted agents, and PARP inhibitors. With the increasing recognition and active biopsy of NEPC lesions, the number of NEPC patients is anticipated to rise. Accumulating more knowledge and experience is crucial in developing novel treatment strategies to combat this disease.
摘要：
神经内分泌前列腺癌（NEPC）通常是前列腺癌的侵袭性形式，可以从头出现或发展为去势抵抗机制。虽然一线铂类化疗对NEPC有效，其有限的反应持续时间和后续治疗带来了重大的临床挑战.由于可用的数据有限，尚未建立标准的二线治疗方法。这篇综述的目的是揭示NEPC二线治疗的现状。使用PubMed和WebofScience进行了文献检索，本综述共包括13篇文章。前瞻性和回顾性研究表明，使用铂类药物联合依托泊苷或多西他赛的二线治疗效果不佳，无进展生存期为3个月或更短。氨柔比星和伊立替康也经常被用作二线治疗，然而,这些药物的疗效一般,缓解持续时间少于6个月.具有同源重组修复基因改变的NEPC患者可能受益于聚（ADP-核糖）聚合酶（PARP）抑制剂的治疗。正在进行的临床研究调查各种药物，包括免疫检查点抑制剂，分子靶向药物，和PARP抑制剂。随着对NEPC病变的认识和主动活检，预计NEPC患者人数将上升。积累更多的知识和经验对于开发新的治疗策略来对抗这种疾病至关重要。
